1. http://mcintranet.musc.edu/agingq3 Risk Factors for Readmission Problem medicationsPrincipal diagnosisPoor health literacyPrior hospitalization Punk (depression)PolypharmacyPatient supportPoor functional status Outpatient CHF Zones for ManagementCOPD Zones for ManagementDiabetes Zones for Management Green Zone: All Clear Your Goal Weight:  No shortness of breath  No swelling  No weight gain  No chest pain  No decrease in your ability to maintain your activity level Green Zone: All Clear  Able to do usual activities  No new symptoms  No chest pain  Your usual medications are controlling your symptoms  No decrease in your ability to maintain your activity level Green Zone: Great Control Your Goal HbA1c: less than 8 percent  HbA1c is under 8 percent  Fasting blood sugar 90-130  Blood sugar less than 180 (one to two hours after eating)  Blood pressure less than 140/80  LDL cholesterol target less than 100mg/dL if no cardiovascular disease  LDL less than 70mg/dL for those with a history of cardiovascular disease (e.g., ischemia, angina, stroke, heart attack) Yellow Zone: Caution If you have any of the following signs and symptoms:  Weight gain of 3 or more pounds  Increased cough  Increased swelling  Increase in shortness of breath with activity  Increase in the number of pillows needed  Anything else unusual that bothers you Work closely with your health care team if you are going into the YELLOW zone Yellow Zone: Caution If you have any of the following signs and symptoms:  Increased cough and/or sputum production  Increase in shortness of breath with usual activity level  Increase in the amount of quick relief medications used  Change in usual energy level: increase in either tiredness or restlessness  Anything else unusual that bothers you Call your nurse if you are going into the YELLOW zone Yellow Zone: Caution If you have any of the following signs and symptoms:  Average blood sugar 150-210  Most fasting blood sugars 130-200  Blood pressure greater than 140/90  More than two low blood sugar reading less than 60 or signs of low sugar (weak, irritated, hungry, sweaty, shaky) In one week Work closely with your health care team if you are going into the YELLOW zone Red Zone: Medical Alert  Shortness of breath that won’t go away or shortness of breath at rest  Chest pain that won’t go away  Wheezing or chest tightness at rest  Need to sit in chair to sleep  Weight gain of more than 5 pounds  Confusion Call your physician immediately if you are going into the RED zone Red Zone: Medical Alert  Unrelieved shortness of breath: shortness of breath at rest  Unrelieved chest pain  Wheezing or chest tightness at rest  Need to sit in chair to sleep  Confusion Call your physician immediately if you are going into the RED zone Red Zone: Stop and Think  Average blood sugars are over 300  Most fasting blood sugars are well over 200  More than three low blood sugar reading less than 60 or signs of low sugar (weak, irritated, hungry, sweaty, shaky) in one week Call your physician immediately if you are going into the RED zone Stage of ChangeAction Precontemplation (Patient not ready to exercise) Encourage patient to consider exercising; tell patient about health benefits of exercise. Contemplation (If patient exercising less than recommended amount) IndependentSupervision Necessary Write prescription; refer to non-clinical fitness professional Refer to clinical exercise professional Preparation (If patient exercising less than recommended amount) Write prescription; refer to non-clinical fitness professional Refer to clinical exercise professional Action and Maintenance (If patient is exercising recommended amount) Encourage continued exerciseEncourage continued supervised exercise Prevention strategies can be classified as primary (preventing the onset of disease), secondary (finding disease in early and curable stages), and tertiary (prevention of further morbidity in established disease). Elderly patients continue to benefit from the primary strategies of vaccination and counseling, but benefit from secondary and tertiary modalities depends on life expectancy and patient acceptance. (Covinsky, 2001) Aging patients are at high risk for re-hospitalization (34% of Medicare patients at 90 days). They may require high levels of interdisciplinary care to prevent further morbidity and mortality. CHF, Pneumonia, and COPD are the top readmission diagnoses. Inpatient https://www.musc.edu/cce/ORDFRMS/pdf/ah_all_dc_pated_diabetesdcinstructions.pdfProchaska and DiClemente, 1982 Recommended vaccinations in patient over 65 years of age VaccineIntervalsContraindications and Precautions dT (replace one booster with Tdap if contact with child <12 months) Every 10 yearsContraindications Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component For Tdap only: Encephalopathy (e.g., coma, decreased level of consciousness, or prolonged seizures), not attributable to another identifiable cause, within 7 days of administration of previous dose of DTP, DTaP, or Tdap. Precautions Moderate or severe acute illness with or without fever Guillain-Barré syndrome (GBS) within 6 weeks after a previous dose of tetanus toxoid-containing vaccine History of Arthus-type hypersensitivity reaction following a previous dose of tetanus and/or diphtheria toxoid-containing vaccine: defer vaccination until at least 10 years have elapsedsince the previous dose For Tdap only: Progressive or unstable neurological disorder, uncontrolled seizures, or progressive encephalopathy until a treatment regimen has been established and the condition has stabilized. PneumovaxOnce after age 65. If < 65 and 5 years have passed – revaccinate once Contraindication Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component. Precautions Moderate or severe acute illness with or without fever InfluenzaYearly during flu season Contraindication Severe allergic reaction (e.g., anaphylaxis) after a previous vaccine dose or to a vaccine component, including egg protein Precautions Moderate or severe acute illness with or without fever History of GBS within 6 wks of previous influenza vaccine ZosterOnce after age 60Contraindication Severe allergic reaction (e.g., anaphylaxis) to a vaccine component Known severe immunodeficiency (e.g., from hematologic and solid tumors, receipt of chemotherapy, or long-term immunosuppressive therapy4 or patients with HIV infection who are severely immunocompromised – CD4<200). Precautions Moderate or severe acute illness with or without fever. Receipt of specific antivirals (i.e., acyclovir, famciclovir, or valacyclovir) 24 hours before vaccination; if possible, avoid use of these antiviral drugs for 14 days after vaccination. www.cdc.govwww.cdc.gov accessed 8/9/12 Poster Rev. 8-10-12 Aging Q3 funded by D.W. Reynolds Foundation